| NPI | 1821295791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 2204) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2022-07-21 |